Provider Demographics
NPI:1306098496
Name:DANIELS, RICHARD DONALD (RN)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DONALD
Last Name:DANIELS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-8701
Mailing Address - Country:US
Mailing Address - Phone:541-301-6621
Mailing Address - Fax:541-552-6055
Practice Address - Street 1:1250 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-5001
Practice Address - Country:US
Practice Address - Phone:541-552-6701
Practice Address - Fax:541-552-6055
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR076036635RN163W00000X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical